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Orthopaedics & Traumatology, Surgery &... Oct 2021Supination-external rotation ankle fracture is one of the most common fractures. Studies on the fracture line distribution of this fracture type are limited. The purpose...
INTRODUCTION
Supination-external rotation ankle fracture is one of the most common fractures. Studies on the fracture line distribution of this fracture type are limited. The purpose of this study is to explore the distribution characteristics of intra-articular posterior malleolus fracture lines in supination-external rotation.
HYPOTHESIS
Most of the fracture lines are concentrated in a particular area.
MATERIAL AND METHODS
Computed tomography scans of a consecutive series of 70 ankle fractures of supination-external rotation were used for this study. The DICOM files were loaded into Mimics 16.0 for 3D reconstruction of the distal tibial articular surface. The intra-articular posterior malleolus fracture lines were identified after virtual fracture reduction. All the fracture lines were drawn on one picture of the distal tibial articular surface after standardization before a heat map was created based on the frequency of fracture lines.
RESULTS
Although the distribution of posterior malleolus intra-articular fracture lines varied, most of them were concentrated in an arcuate zone. The ratios of the area of posterior fracture fragment to the total area of articular surface averaged 14.96% (range, from 2.23% to 38.45%). They were most likely to enter the articular surface at 20.4% of the tangent of the posterior edge in a standardized image and exit at 58.7% of the tangent of the lateral edge.
CONCLUSIONS
In ankle fractures of supination-external rotation, most intra-articular posterior malleolus fracture lines may be distributed regularly in an arcuate zone of the articular surface.
LEVEL OF PROOF
V; Descriptive research.
Topics: Ankle Fractures; Ankle Joint; Fracture Fixation; Fracture Fixation, Internal; Humans; Supination
PubMed: 34216839
DOI: 10.1016/j.otsr.2021.103000 -
Foot & Ankle International Feb 2015The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a... (Comparative Study)
Comparative Study
BACKGROUND
The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture.
METHODS
Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed.
RESULTS
The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively.
CONCLUSION
The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Topics: Adult; Aged; Ankle Fractures; Ankle Injuries; Ankle Joint; Female; Fracture Fixation, Internal; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tibia; Tomography, X-Ray Computed
PubMed: 25278340
DOI: 10.1177/1071100714553470 -
Injury Jun 2022Early rehabilitation training after ankle fracture surgery is critical to healing and avoiding complications. Inappropriate or excessive motion may impede healing or...
BACKGROUND
Early rehabilitation training after ankle fracture surgery is critical to healing and avoiding complications. Inappropriate or excessive motion may impede healing or even lead to secondary injury. Currently, there is a lack of scientific quantitative postoperative rehabilitation methods after ankle fracture. Our purpose was to develop a universal method of quantifying early passive rehabilitation training after surgery by finite element (FE) analysis.
METHODS
A three-dimensional (3D) FE model of normal ankle was reconstructed from a computed tomography scan of a healthy male adult. Six types of ankle fractures were considered based on AO classification. We exerted joint motion load to explore the effect of movement on ankle joint mechanics after surgery. The corresponding relationship between the Inter-bone displacement and range of motion was measured to quantifying the ankle range of motion. The 44A3.3 fracture was used as an example to describe the implementation process in detail.
RESULTS
During ankle movement, most of the stress was sustained by the internal fixation devices, and the ratio of stress borne by the implants ranged from 67.9 to 94.9%. Flexion/extension exercise did not cause extra stress on the ankle contact surfaces. Ligament traction was the reason for ankle load during flexion/extension motion. The range of early passive postoperative rehabilitation training for six types of ankle fractures (AO classification) were provided.
CONCLUSION
A quantitative method of early passive rehabilitation training after ankle fracture surgery was developed using FE analysis. This modeling method has universality for any fracture that can be reconstructed.
Topics: Adult; Ankle Fractures; Ankle Injuries; Ankle Joint; Finite Element Analysis; Fracture Fixation, Internal; Humans; Male; Range of Motion, Articular
PubMed: 35400487
DOI: 10.1016/j.injury.2022.03.067 -
Clinics in Podiatric Medicine and... Jul 2023Using ankle arthroscopy in conjunction to open reduction internal fixation of traumatic ankle injuries can play an important role in the management of these injuries by... (Review)
Review
Using ankle arthroscopy in conjunction to open reduction internal fixation of traumatic ankle injuries can play an important role in the management of these injuries by way of treating intra-articular pathologies, leading to improved patient outcomes. While a majority of these injuries are not treated with concurrent arthroscopy, its addition may lead to more prognostic information to dictate the patient's course. This article has illustrated its use in managing malleolar fractures, syndesmotic injuries, pilon fractures and pediatric ankle fractures. While additional studies may be needed to further support AORIF, it may prove to play a vital role in the future.
Topics: Humans; Child; Ankle; Arthroscopy; Ankle Injuries; Ankle Fractures; Ankle Joint; Fracture Fixation, Internal; Treatment Outcome; Retrospective Studies
PubMed: 37236689
DOI: 10.1016/j.cpm.2022.12.003 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jan 2022To summarize the diagnosis and treatment of fibular fracture in ankle fracture.
OBJECTIVE
To summarize the diagnosis and treatment of fibular fracture in ankle fracture.
METHODS
Relevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification.
RESULTS
Conservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment.
CONCLUSION
First of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
Topics: Ankle; Ankle Fractures; Ankle Injuries; Ankle Joint; Fibula; Fracture Fixation, Internal; Humans
PubMed: 35038809
DOI: 10.7507/1002-1892.202108091 -
Journal of Orthopaedic Trauma Aug 2016Rotational ankle fractures are incredibly common, resulting in a wide spectrum of bony and ligamentous injury patterns. After open reduction of an ankle fracture, the... (Review)
Review
Rotational ankle fractures are incredibly common, resulting in a wide spectrum of bony and ligamentous injury patterns. After open reduction of an ankle fracture, the treating surgeon must always evaluate syndesmotic stability. If the syndesmosis is determined to be unstable, a reduction of the distal tibiofibular joint should be performed. Failure to adequately identify and treat injuries to the syndesmosis may result in continued ankle instability and poor patient outcomes. Lateral fluoroscopic images are necessary to assess a closed reduction of the syndesmosis before stabilization, although the accuracy of this tool has been questioned in several studies. Significant controversy surrounds many aspects of this injury and its treatment, including methods of diagnosis, ideal reduction clamp positioning, diameter and number of syndesmotic screws, and number of tibial cortices to be engaged. In the accompanying video, we describe our approach for the treatment of a bimalleolar ankle fracture with syndesmotic injury, using a posterior fibular plate and single tricortical syndesmotic screw.
Topics: Ankle Fractures; Ankle Injuries; Combined Modality Therapy; Evidence-Based Medicine; Fibula; Fracture Fixation, Internal; Humans; Multiple Trauma; Open Fracture Reduction; Treatment Outcome
PubMed: 27441940
DOI: 10.1097/BOT.0000000000000588 -
The Journal of Orthopaedic and Sports... Sep 2014Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
To compare early ankle movement versus ankle immobilization after surgery for ankle fracture on clinical and patient-reported outcomes.
BACKGROUND
A significant proportion of patients undergoing surgery for ankle fracture experience postoperative complications and delayed return to function. The risks and benefits of movement of the ankle in the first 6 weeks after surgery are not known, and clinical practice varies widely.
METHODS
We searched bibliographic databases and reference lists to identify eligible trials. Two independent reviewers conducted data extraction and risk-of-bias assessments.
RESULTS
Fourteen trials (705 participants) were included in the review, 11 of which were included in the meta-analysis. The quality of the trials was universally poor. The pooled effect of early ankle movement on function at 9 to 12 weeks after surgery compared to immobilization was inconclusive (standardized mean difference, 0.46; 95% confidence interval: -0.02, 0.93; P = .06; I(2) = 72%), and no differences were observed between groups at 1 year. The odds of venous thromboembolism were significantly lower with early ankle movement compared to immobilization (Peto odds ratio = 0.12; 95% confidence interval: 0.02, 0.71; P = .02; I(2) = 0%). Deep surgical site infection (Peto odds ratio = 7.08; 95% confidence interval: 1.39, 35.99; P = .02; I(2) = 0%), superficial surgical site infection, fixation failure, and reoperation to remove metalwork were more common after early ankle movement compared to immobilization.
CONCLUSION
The quality of evidence is poor. The effects of early movement after ankle surgery on short-term functional outcomes are unclear, but there is no observable difference in the longer term. There is a small reduction in risk of postoperative thromboembolism with early ankle movement. Current evidence suggests that deep and superficial surgical site infections, fixation failure, and the need to remove metalwork are more common after early ankle movement. Level of Evidence Therapy, level 1a-.
Topics: Ankle; Ankle Fractures; Casts, Surgical; Early Ambulation; Fracture Fixation; Humans; Postoperative Care; Postoperative Complications; Recovery of Function; Risk Factors
PubMed: 25098197
DOI: 10.2519/jospt.2014.5294 -
Journal of Healthcare Engineering 2021Few studies exist on the predictive factors of tibial fractures with hidden posterior ankle fractures.
BACKGROUND
Few studies exist on the predictive factors of tibial fractures with hidden posterior ankle fractures.
OBJECTIVE
To study the incidence and predictive factors of tibial fractures with occult posterior ankle fractures.
METHODS
Tibial fracture patients were prospectively selected who were admitted to our hospital from January 2016 to May 2021 and their general clinical data, X-ray images, CT images, and other imaging data were collected and then divided them into posterior malleolus fracture group and nonposterior malleolus fracture group according to the presence or absence of posterior malleolus fractures. Multivariate regression analysis and receiver operating curves (ROC) were performed to analyze the influencing factors of tibial fracture with occult posterior ankle fracture.
RESULTS
CT showed that 25 (13.44%) patients had occult posterior ankle fractures among 186 patients with tibial fracture. There was no significant difference in gender, age, and locations of tibial fracture between the two groups ( > 0.05). There were statistical differences in the types, locations, and lengths of patients with tibial fracture but without posterior malleolus fractures. The length of the tibia fracture group was significantly lower than the tibia with posterior ankle fracture group ( < 0.05). Logistics regression analysis showed that tibial fracture with occult posterior ankle fracture was not significantly correlated with gender, age, and location of tibial fracture ( > 0.05), but was significantly correlated with tibial fracture type, location, and length (HR = 1.830, =0.035; HR = 5.161, =0.004; HR = 1.126, =0.030). The ROC curve showed that the AUC of length of tibial fracture with occult posterior ankle fracture was 0.599. The YD index suggested that the best cut point for the prediction of tibial fracture with occult posterior ankle fracture was above 13.18%. The sensitivity and specificity of spiral tibial fracture and distal 1/3 tibial fracture for prediction were 88.00% and 63.35%, 92.00%, and 58.39%, respectively, which was significantly higher than that of tibial fracture length ( < 0.05).
CONCLUSION
Patients with tibial fractures have a higher incidence of occult posterior ankle fractures. Spiral tibial fractures and distal 1/3 tibial fractures have a higher predictive value for tibial fracture with occult posterior ankle fractures and can help clinical detection as soon as possible, which is a more accurate and appropriate treatment.
Topics: Ankle Fractures; Ankle Joint; Humans; Incidence; Retrospective Studies; Tibial Fractures
PubMed: 34925733
DOI: 10.1155/2021/4392595 -
The Journal of Foot and Ankle Surgery :... 2023Primary repair of the deltoid ligament is a common surgical option for unstable ankle fracture. However, controversy exists regarding whether such repair is necessary or...
Primary repair of the deltoid ligament is a common surgical option for unstable ankle fracture. However, controversy exists regarding whether such repair is necessary or provides any benefit to patient outcomes. A retrospective study was performed following acute deltoid repairs using all-suture bone anchors. Patients at 2 surgical centers were included when they were over 18 years old at surgery, had a medial clear space (MCS) greater than 4 mm preoperatively, and had at least 6 months of follow-up. Subjective outcomes were measured with PROMIS, FAAM, and numeric rating scale. Preoperative and follow-up scores were compared with t tests (p < .05). For the 47 patients identified, age at time of surgery was 30.6 ± 14.9 years (range 15.4-65.0 years). Follow-up data were captured for 36 (73%) of the patients at 75 ± 37 weeks (range 18-169 weeks) after surgery. Mean time to weightbearing was 4 ± 1 weeks (range 1-7 weeks). Patients returned to sport 14 ± 5 weeks after surgery (range 8-41 weeks). Various complications consisted of wound infection, superficial dehiscence, and complex regional pain syndrome (CRPS). The PROMIS, FAAM, and NRS patient outcome scores improved significantly from preoperative to postoperative follow-up. Significant reduction in the radiographic MCS postoperatively occurred in all patients. These findings suggest primary deltoid repair when associated with ankle fracture to be a safe procedure and has the potential of allowing early weightbearing and return to sports.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Aged; Ankle Fractures; Suture Anchors; Retrospective Studies; Ligaments, Articular; Fracture Fixation, Internal; Ankle Joint; Treatment Outcome
PubMed: 37037736
DOI: 10.1053/j.jfas.2023.03.002 -
Danish Medical Journal Nov 2022Information on data validity is essential for understanding the precision of studies based on data from the Danish National Patient Registry (DNPR). Thus, the aim of...
INTRODUCTION
Information on data validity is essential for understanding the precision of studies based on data from the Danish National Patient Registry (DNPR). Thus, the aim of this study was to validate the quality of ankle fracture data in the DNPR.
METHODS
We identified all patients from four hospitals with a surgically treated ankle fracture between 1 January 2018 and 31 December 2018. The positive predictive value (PPV) was estimated for a random sample of 10% of patients with both a relevant ankle fracture diagnosis code and a relevant procedure code, as well as for patients with only a relevant ankle fracture diagnosis code or a relevant ankle fracture procedure code. We collected data from medical records and X-rays. Two consultants independently validated the ankle fracture diagnosis and procedure codes reported to the DNPR.
RESULTS
Among the four centres, 651 patients were identified with both an ankle fracture diagnosis and a procedure code. Among these, data from 65 (10%) patients were extracted for validation. For these patients, the PPV for an ankle fracture was 0.95 (95% confidence interval (CI): 0.88-0.99). The PPV for the diagnosis code was 0.89 (95% CI: 0.79-0.95), and for the procedure code, the PPV was 0.82 (95% CI: 0.70-0.90). For patients with only an ankle fracture diagnosis code or only a surgical procedure code, the PPV for an ankle fracture was 0.77 (95% CI: 0.64-0.87).
CONCLUSION
This study showed that ankle fracture diagnosis and procedure codes registered in the DNPR are of a high quality and thus constitute a valuable data source for research on ankle fractures.
FUNDING
none.
TRIAL REGISTRATION
The Danish Data Protection Agency approved the study (journal number 2015-18/62866).
Topics: Humans; Predictive Value of Tests; Ankle Fractures; Medical Records; Registries; Denmark
PubMed: 36458605
DOI: No ID Found